WASHINGTON — President Trump’s commission on combating the opioid epidemic plans to encourage the federal government to establish drug courts in every federal judicial district, adjust reimbursement rates for addiction treatment, and streamline federal funding used by state and local governments to implement drug treatment and prevention programs, according to a draft of the panel’s final report.

Those steps are among the 53 recommendations laid out in the draft, a copy of which was obtained by STAT. The final report is set to be released on Wednesday.

The highlights:


Drug courts in all federal judicial districts

As of 2015, according to the commission, less than one-third of federal judicial districts and 44 percent of U.S. counties operated drug courts, which serve as alternatives to the traditional court system and have been shown to increase engagement in addiction treatment and reduce recidivism rates. The commission will recommend the Department of Justice establish drug courts in every federal district, and that individuals with substance use disorder who violate probation terms be diverted to a drug court as opposed to prison.

Drug courts combine elements of criminal justice and addiction treatment to help those with substance use disorder avoid criminal sentencing, provided participants comply with a treatment course that can include counseling and medication-assisted treatment.


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Streamline federal funding opportunities

Staffers in nearly nearly every governor’s office, according to the report, expressed concern about opioid-related funding from the federal government being “fragmented.”

The commission will recommend a system for distributing federal funding that expands and mirrors the process for obtaining block grants offered by the Substance Abuse and Mental Health Services Administration. That process should require only one application and result in states receiving at least equivalent funding while allowing them to redirect resources currently used for paperwork toward program implementation.

Changes to reimbursement rates set by federal addiction treatment providers

The commission will recommend that the Centers for Medicare and Medicaid Services review policies that incentivize the prescription of opioids over more expensive non-opioid treatments.

It will also urge the Department of Health and Human Services to review its rates to more adequately measure and cover the “true costs” of treating substance use disorder, including use of inpatient psychiatric facilities.

The report recommends lowering barriers to substance use disorder treatment, including those that impose limits on access to any of the three forms of medication-assisted treatment approved by the Food and Drug Administration. Separately, the report recommends increasing access to recovery coaches.

Allow more emergency responders to administer naloxone

A best-practices guide issued by the National Highway Traffic Safety Administration — which oversees the federal Office of Emergency Medical Services — currently recommends that paramedics and advanced medical technicians be allowed by local communities to administer naloxone, the overdose-reversal drug. The report recommends the those guidelines be reviewed to allow emergency medical technicians to also administer the medication, and in higher doses.

Several states currently prohibit some classifications of emergency responders from administering naloxone.

Tighten requirements for prescribers

The report will recommend the Drug Enforcement Administration require prescribers seeking to renew licenses to prescribe opioids first demonstrate they have participated in an education program regarding the drugs’ prescription. The report also recommends that HHS develop a “national curriculum and standard of care for opioid prescribers,” and that pharmacists receive training “on best practices to evaluate the legitimacy of opioid prescriptions.”

Eliminating patient pain evaluations from surveys

The commission will recommend that CMS eliminate questions about pain levels from patient satisfaction surveys, thereby ensuring that providers are not incentivized to prescribe opioids in order to increase measured patient approval.

Steps to ensure parity

The draft report says federal and state regulators should have better ways of measuring health providers’ compliance with parity laws, which require providers to provide and fund services for mental health and addiction on an equal basis to other health conditions.

Media campaign

The White House, the commission will recommend, should fund and coordinate with private-sector and nonprofit groups to implement a “wide-reaching, national multi-platform media campaign addressing addiction stigma and the danger of opioids.” The report likens the effort to a similar initiative launched during the HIV/AIDS epidemic of the 1980s and 1990s.

In another prevention initiative, the report recommends a collaboration between states and the Department of Education to implement student assessment programs to identify at-risk youth in middle school, high school, and college in need of treatment.

The report will also recommend implementing policies that ensure patients are adequately educated about the “risks, benefits, and alternatives of taking opioids” before receiving an opioid prescription for chronic pain.

Expand compliance with the Prescription Drug Monitoring Act

The report will push the White House to endorse the Prescription Drug Monitoring Act, legislation currently before Congress that would require states receiving federal grant money to comply with regulations for prescription drug monitoring programs and share data with a national hub to be established by the Department of Justice.

Separately, the commission recommended integrating PDMP data with electronic health records systems, and that the DEA and the Office of National Drug Control Policy increase electronic prescribing to prevent forgery and drug diversion.

Better data on overdose deaths

“We do not have sufficiently accurate data from medical examiners around the country to determine overdose deaths,” the report reads. It directs the federal government to develop forensic and toxicology procedures for use while investigating drug-related deaths.

Leveraging Public Health Service personnel

The report recommends the White House deploy health care workers from the Public Health Service Commissioned Corps to administer treatment and care in areas with above-average opioid use.

Bolstering research money

The director of the National Institutes of Health, Francis Collins, has acknowledged already that while he hopes the agency will continue to play a major role in addressing the drug crisis, it will be unable to significantly do so by merely redirecting some of its current funding. The commission agrees, and cited three institutes within NIH it deems worthy of increased research funding: the National Institute on Drug Abuse, National Institute of Mental Health, and National Institute on Alcohol Abuse and Alcoholism. It did not specify recommended funding levels.

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  • Since when do pharmacists have a right to be in our physicians offices? Our physicians know our medical needs. If we are given an opioid medication that is between myself and my physician. This has gone way to far. When the government and these agencies realize and finally look at the statistics from overdoses, and it comes out it is from illegal opioids what will they do then? Now they want to place the blame on physicians and patients with legitimate prescriptions for chronic pain diseases, because this is the easiest targets. When all the illegal fentynal and heroin manufacturers and distributors are being overlooked.
    Us legitimate chronic pain disease patients are being abandoned, discriminated against and overlooked.
    They want to make sure the addicts are comfortable and given opioids for the treatment of addiction. But chronic pain disease patients are left to suffer with debilitating pain.
    Chronic pain is a disease. Addiction rate for legitimate pain disease patients is 02-.6%, we are not the problem. We need help. We are patients not addicts.

  • The real losers in this will be the people (patients) with a legitimate need for opioids to treat their chronic and severe pain. They will get the double whammy — forced drug withdrawal (going “cold turkey” is not a pleasant process) and increased pain.

    You heard it here, first. (if not first, close to it.)

  • Pain patients need to be taken care of, and they are not. The CDC “guidelines” were pushed on our doctors as supposed “recommendations” with consequences ranging from audit to losing of their license if they did not comply, so the doctors did everything from dropping medication levels to a quarter of their prior amount, to dropping patients altogether. These patients have no recourse, and after being forced to suddenly withdraw from a medication their bodies have become used to, are left with no quality of life because they cannot go about daily duties while in such pain.

    Even having medication levels dropped causes withdrawal. The doctors are so afraid of repercussions that they are not doing what is right for the patient, and they feel forced to do it this way in order to keep their license.

    It is not just chronic pain patients who go through this. Lyme, rheumatoid arthritis, regular arthritis, nerve damage, migraines, endometriosis, diseases of the spine, rotator cuff injuries and surgeries, a thousand other diseases and injuries cause pain either before or after surgery or chronically — these patients are the casualties. I have heard more than one promise to commit suicide rather than go back to the debilitating, disabling, and life-draining pain they were in before. Losing one person because of this is too many.

    Then the government tries to outlaw kratom — one of the few natural plants out there capable of actually helping with pain, PTSD, anxiety (it can even help you quit smoking) without doing their due diligence to make sure it actually causes a problem. It doesn’t. You can’t even overdose on it — it causes a person to throw up before that ever happens. And taking more does not equal more effects, since it also contains an antagonist it will actually start reversing the effects rather than increase them, keeping dosages low. It’s a self-moderating pain relief plant, and I wish more people with pain knew about it.. also wish the government was not intent on taking it away.

    In any plan for people addicted to a substance, people legitimately taking it need to be taken into account and taken care of. They are not the ones at fault, yet are being punished. There are only a few doctors willing to stand up for pain patients so far, but I am hoping more will stand up for what is right.

    If what Mr. Chao has stated is true about Australia and Portugal then we should definitely look at what they have done. There is no harm and no weakness in following a tried and true formula. Bring it all into the sunshine where it can be seen and then helped.

    Good luck, everyone.

  • I don’t disagree with accountability, but someone better do something about all these bs diagnoses like fibromyalgia and chronic regional pain syndrome (they are symptoms of a bigger systemic issue)….Drs and CDC are in kahoots with big pharma!! Get on with finding a cure for Lyme disease and other intracellular bacterial infections they pretend don’t cause those aforementioned disabling diseases, where the only way people can make it through is with pain meds, bc drs and cdc turn a blind eye!!

    • @Bruce – opioids are not supposed to do anything for non-diabetic neuropathy pain, either, yet they can help quite a bit with other types of neuropathy pain.

      There is no explanation at this time why opioids help some with fibromyalgia and not others. I’ve seen it noted as a last ditch effort after everything else has been tried, and it is hypothesized that there may be a concurrent issue that the opioids help calm the pain for, which then calms down the fibromyalgia. In cases like those, the opioids may not directly affect it, yet still end up lessening the patient’s pain.

      If they are over-prescribed or given when unnecessary that is something that should change. However, if they are helping the patient then they should not be taken away or be capped at a certain “maximum upper limit.”

      Patients have to go through a pretty intense medication regimen, trying different medications and then different strengths, to see what works the best. Then once they are on the optimum dosage, they maintain that — until the CDC walks in and limits the amount the doctors are able to prescribe. The CDC does not know patients or their needs, just like nobody on a website comment section can say what an unknown person with fibromyalgia needs. The patient’s well-being and quality of life is what is important, and I’ve seen little mention of making sure they get to keep what little they have.

    • Bruce, wrong. I am a fibromyalgia patient who has been stable and functioning on a low dose weak opioid-based medication for over 11 years. I tried many different treatments prior to taking this medication. In the 11 years I’ve been taking this medication, I have went from a suicidal patient who could not work to a stable, functioning patient who also incorporates other treatments along with the opioid-based medication. My dose has not changed throughout the years. I work two part-time jobs, along with taking care of my house, yard, numerous pets and, most importantly, have some quality to my life ONLY because the opioid-based medication has effectively reduced my pain to a tolerable level. Don’t ever assume or attempt to dictate what works for me, as it is MY body, not yours.

  • Well done reporting
    Will be of interest how Policy
    Is acted on effectively and efficiently
    Complex social disparity issues
    With needed Health equity solutions
    Also will media campaign resonant

  • The way we treat addiction and drug abuse in this country is totally wrong. If we are to stop heroin addiction it is more than asking people to just say no. Stronger laws are not helping. In Australia – they found that legalizing heroin and other drugs allowed them to identify the people who needed help and then drive them into treatment programs. I believe a similar program is in effect in Portugal and Spain. I met a UN commissioner who was a judge in the Australian program. He explained to me this caused the almost complete elimination of drug overdoses and has drastically reduced drug use in his country. Why can’t anyone talk about programs that have worked instead of continuing the war on drugs which was started by President NIXON. I am a doctor. I do not prescribe this class of drugs but it pains me to see people suffering because of our lack of training and preparation for this terrible epidemic. In any other disease which causes hundreds of people to die a day I am told…. we would be doing more. President TRUMP please help us. Let’s talk to the Aussies and the portugese and get some input from programs that actually have worked.

  • Existing long term chronic pain sufferers that take opiods as prescribed by their docs and pain mgmnt. clinics should not be hampered by this fanfare. Look at the report. Nothing there that would require stopping legal use as is that has helped so many of us. My fear is that many politicians and business leads will suck up to Trump (and governers ) and go overboard by making opiod access extremely difficult when it should not be. Those of us that take our opiod pain killers as prescribed and visit our pain mgmnt doctors should not be victimized.

    • I fully agree. But the lip srevice they have is sickening. The discrimination we face will persist. Pharmacists are the last person with knowledge of my medical history. How are they given powers, when they deny based on profiling,like if you have tatoos,denied. Didnt shave cause pain causes difficulty,denied. There are a bunch of profiling stories. I cant even see how we are going to be better off. And, i never see pain mgt in caps. As Osteo,Cancer,r etc. All doctors are schooled on pain treatments and meds. This is just wierd. Pcp drs are just as skilled as others. And pain mgt drs are mds. Same dr i see. No special training. Just alot of compliance,forced,to recieve treatment. And, discrimination,harrassment and nevative dehumanizing treatment endured by us. This is wrong on so many levels. These boards dnd advisors are missing alot. Cdc data was proven to be false. Here:<1% of chronic pain sufferers prescribed opioids in 2016 died. And theres alot more thats not being included. Facebook,twitter has tons of us. How can we fight if they take away meds that provide q of l if were in unrelenting pain. Yoga in the super market? Meditate while driving? When the guy in line is meditating to get s few minutes relief,what will those waiting say or do? CALL HIM ASSHOLE.thanks stump,your a genius

    • Except that in the real world many chronic pain patients who were receiving opioids and using them according to instructions have already had their treatment interrupted, and are now labelled addicts. Those patients now simply suffer, with no effective alternatives offerred to many of them.

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